Healthcare Provider Details

I. General information

NPI: 1538639059
Provider Name (Legal Business Name): LISA THORPE LPC, LCADC, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 PLAINFIELD AVE
EDISON NJ
08817-2592
US

IV. Provider business mailing address

70 WINDING RIDGE DR
NEPTUNE NJ
07753-8109
US

V. Phone/Fax

Practice location:
  • Phone: 732-985-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01138900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00276400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: